Rental Security Deposit Complaint Form by otj26205

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									TO: SECURITY DEPOSIT INVESTIGATOR                   YOU MUST               YOUR COMPLAINT WILL NOT BE
    DEPARTMENT OF BANKING                           COMPLETE               PROCESSED WITHOUT THE
    260 CONSTITUTION PLAZA                          ALL ITEMS !            REQUIRED DOCUMENTATION
    HARTFORD, CT 06103


COMPLAINT FILED BY: Mr./Mrs./Ms. _____________________________________________________________

FULL ADDRESS ______________________________________CITY__________________STATE____ZIP_______

TELEPHONE: Home ________________                         Business ________________

This complaint is filed against the landlord named below for failing to: (please check)

                      [ ] Pay interest on a security deposit           [ ] Return a security deposit


    YOU MUST PROVIDE THE LANDLORD WITH A FORWARDING ADDRESS BY CERTIFIED MAIL
          Have you done this? ________Date forwarding address was given: _______Attach a copy *


LANDLORD: Mr./Mrs./Ms. ________________________________________________________________________

FULL ADDRESS ______________________________________CITY___________________STATE____ZIP_______

TELEPHONE: Home ________________                         Business ________________

APARTMENT OR HOUSE RENTED:

FULL ADDRESS________________________________________CITY_____________________________ZIP______

Name of Housing Complex (if any) ____________________________________________________________________

Amount of monthly rental       $ ____________            Amount of security deposit $________________________

Did you have a lease            ____________             If not noted on your lease, do you have a receipt for your
(If so enclose a copy*)                                  security deposit?_____ Enclose a copy.*
         OR
Month-to-month rental?          ____________             Amount of any other deposit $_______________________
                                                         (Specify) ________________________________________

Date occupancy started          ___________              Date you last paid rent ____________

Date occupancy terminated       ____________

Has interest ever been paid on your security deposit? ________ Date _____________ Amount $_________________

Has any part of your security deposit been returned? ________ Date _____________ Amount $_________________

Has the landlord sent you a letter regarding your security deposit? _________ If so, please enclose a copy.

Dated _________________________                  Your Signature _____________________________________________

                                 (Please use reverse side for additional comments)
                               PLEASE ENCLOSE ALL REQUESTED COPIES
                         *ABSOLUTELY NECESSARY TO PROCESS YOUR COMPLAINT

								
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